MEDICARE: JOHNY ELIE FARES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD484433	PA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207RR0500X	Rheumatology Physician	MD484433	PA

General Provider Information

NPI Number	:	1942761051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNY ELIE FARES MD

Provider Business Mailing Address
First Line	:	3803 W CHESTER PIKE STE 160
Second Line	:
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-2336
Country	:	US
Telephone Number	:	484-337-1632
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 E LANCASTER AVE
Second Line	:	MOB WEST SUITE 135
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-3435
Country	:	US
Telephone Number	:	484-476-1190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2019
Last Update Date	:	08/07/2024

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